Provider Demographics
NPI:1497908248
Name:WAHL, TRICIA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:M
Last Name:WAHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-545-2800
Mailing Address - Fax:808-262-3744
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-545-2800
Practice Address - Fax:808-262-3744
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053666363A00000X
HIAMD-504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant